delivering service excellence in health industry

What’s up, Doc?: Delivering Service Excellence in Health Industry

June 22, 2012; 6 – 9 pmAteneo Professional Schools Auditorium

Rockwell, Makati

MBA students from all the programs of AteneoMedical students from Ateneo School of Medicine and Public Health

What’s up, Doc?: Delivering Service Excellence in Health Industry

MBA students from all the programs of Ateneo

Medical students from Ateneo School of Medicine and Public Health

What’s up, Dr. Rey Joson?

What are your

thoughts, perceptions, opinions and recommendations (TPORs)

on delivering service excellence in the health industry in the Philippines with focus on hospitals?

ROJ’s TPORs on Delivering Service Excellence in Health Industry with Focus on Hospitals

Outline of Presentation

• When does one say there is service excellence in the health industry?

• When does one say there is service excellence in the hospital industry / in hospitals?

• .………..

• ………...


Outline of Presentation• .………..• ………...• What are some recommended strategies for

delivering service excellence in hospitals? • What are the most difficult (outstanding)

challenges in delivering service excellence in hospitals?


Questions (ROJ) Questions (Organizers) – Reference: MDH

•Service excellence in the health industry?

•Service excellence in the hospital industry / in hospitals?

Demonstration of service excellence Operating environment and key relationships

with patients and stakeholders, suppliers and partners

Well-being of society Legal and ethical requirements

•Some recommended strategies ?

What strategies How implemented How measured How communicated Cost-effectivity

•Most difficult (outstanding) challenges ?

Challenges

Q1. When does one say that the health industry in the Philippines is delivering service excellence?

The health or medical industry -

a sector within the economic system

that provides services and goods

to people with health concerns.


Health or medical industry – a conglomeration of

• regulatory bodies and offices on health programs, goods, and services;

• health care facilities; • health care products and their manufacturers and

sellers; • health care practitioners and providers; • health care insurances; • health and medical educational and research

institutions; • other activities associated with human health.


Just like any other industry,

health or medical industry is expected to deliver, in a collective effort, excellent services and products to the community.

Question:

what criteria and indicators do we use?


Look atHealth care outcomes of catchment community –

Philippines, a province, a city, etc.Criteria Indicators

Average life span Acceptable percentage of Filipinos reaching targeted life span (e.g. 70 years old)

Infant mortality rate Acceptable rate (25 / 1000 vs 19 / 1000)

Maternal mortality rate Acceptable rate (94 / 100,000 vs 52 / 100,000)

Control of specific diseases

Controlled incidence, prevalence, mortality and morbidity rates (e.g. control of dengue and non-communicable diseases)

Quality of life index Acceptable rate (e.g. 7 vs 8 score – QLI; suicide rate

Access to health care Acceptable indices

Others


Look atHealth care outcomes of catchment community –

Philippines, a province, a city, etc.Criteria Indicators

Average life span Acceptable percentage of Filipinos reaching targeted life span (e.g. 70 years old)

Infant mortality rate Acceptable rate (25 / 1000 vs 19 / 1000)

Maternal mortality rate Acceptable rate (94 / 100,000 vs 52 / 100,000)

Control of specific diseases

Controlled incidence, prevalence, mortality and morbidity rates (e.g. control of dengue and non-communicable diseases)

Quality of life index Acceptable rate (e.g. 7 vs 8 score – QLI; suicide rate

Access to health care Acceptable indices

Others

Are the set and agreed indicators being achieved or

not?

If yes, EXCELLENT!If no, NOT or “NOT SO”

excellent!

National / Local Government Health Departments

Q2. When does one say that a hospital is delivering service excellence? What makes a hospital excellent?

Excellent hospitals contribute to the achievement of targeted health outcomes in catchment community.

Catchment Community Targeted Health Care

Outcomes

Life spanInfant mortality rate

Maternal mortality rateControl of specific

diseasesQuality of life

Access to health careOthers

Hospital

Programsfor targeted health care outcomes


Cost-effective-efficient medicine

Value-based medicine(Porter & Teisberg)

Quality and safe medicine

Evidence-based medicine

Excellent hospitals provide value-based health services (inclusive of cost-effective-efficient, quality and safe services).


Value-based Medicine or Health Services

• Value created for and appreciated by patients served and for services rendered.

• Value = health outcomes achieved per peso spent, not just access, convenience, volume, and cost containments.


Value-based Medicine or Health Services

• Good health care outcomes (good results) on community and individual patient indices

• Quality and safe services

• Reasonable costs and expenses


ROJoson’s Survey on Excellent Hospital (2010)[141 Hospital Administrators; Physicians; Non-physician Health Care

Providers; Patient-clients]

Parameters of Excellence Overall Frequencies

With affordable / reasonable hospital / medical costs

52%

With financial sustainability program 46%

With state-of-the-art equipment 40%

With quality and patient-friendly infrastructure and facilities

40%

With quality services 30%


Excellent hospitals are those that are managed to be sustainable while providing excellent services.

A hospital is sustainable if it has the ability to continue

to achieve its operating objectives and fulfill its mission

over the long term and is resilient over time!

ROJ TPORs on Sustainability of a Hospital

Financial Sustainability

Management Practice Sustainability

Indicators:• Constantly positive net

income• Constantly adequate

liquid asset• Constantly manageable

debt burden

Indicators (COMPLIANT):• Baldrige Health Care

Criteria for Performance Excellence

• Quality and safe patient care standards

• Investors in People

ROJ TPORs on Sustainability of a Hospital

Programs Ultimate Goal

Business development for the whole hospital and its units

Maximal utilization of services

Financial management NO unwarranted lossesEnough revenues and incomes to continue and expand

Business continuity and disaster resiliency

Business continuity after a disaster

Corporate social responsibility

Sustenance of catchment community


Excellent hospitals are those that are managed to be sustainable while providing excellent services.

Excellent hospitals contribute to the achievement of targeted health outcomes in catchment community.

Excellent hospitals provide value-based health services (inclusive of cost-effective-efficient, quality and safe services).

Q3. What are some recommended strategies in

delivering service excellence in hospitals?

Strategic Framework:

• Set 3 key indicators of an excellent hospital as goals.

• Design and develop hospital performance excellence program.

• Get committed support of top management and staff.

• ………• ………• ………



Strategic Framework:

• ……….• ……….• ……….• Implement program perseverently.• Evaluate results of implementation.• Continually improve program until 3 key

indicators of performance excellence are achieved to the highest degree.



Strategic Framework Facilitating Strategies

Design and develop hospital performance excellence program

• Baldrige Health Care Criteria for Performance Excellence

• Joint Commission International or Accreditation Canada International accreditation for hospitals

• PhilHealth Benchbook

Implement program Investors in People standards

Evaluate results of implementation

Balanced scorecard

Baldrige Health Care Criteria for Performance Excellence

US-based standard designed to help hospitals use an integrated approach to organizational performance management that can result to:

• Delivery of ever-improving value to patients and other customers, contributing to improved health care quality

• Improvement of overall organizational effectiveness and capabilities as a health care provider

Questions and guides on how to achieve performance excellence for hospitals

Comparison of Patient-care StandardsAccreditation Canada Joint Commission International PhilHealth Benchbook

Individual Client/Patient Care Groups (14) that correspond to particular episodes of care and treatment

Information Management

Human Resources Development and Management

Environmental Management

Leadership and Partnerships (one team for management and one team for governance standards)

Patient-centered Standards

• Access to Care and Continuity of Care• Patient and Family Rights• Assessment of Patients• Care of Patients• Anesthesia and Surgical Care• Medication Management and Use• Patient and Family Education

Health Care Organization Management Standards

• Quality Improvement and Patient Safety• Prevention and Control of Infections• Governance, Leadership, and Direction• Facility Management and Safety• Staff Qualifications and Education• Management of Communication and

Information

• Patient Rights and Organizational Ethics

• Patient Care

• Leadership and Management

• Human Resource Management

• Information Management

• Safe Practice and Environment

• Performance Improvement

Investors in People Standards

Business improvement tool designed to advance an organization's performance through its

people!

Balanced Scorecard

Blueprint formulated by organization to be used as a guide and reference for

• implementation of strategies and tactical objectives

• monitoring • evaluation of actions taken

Management strategic tool as well as performance measurement system

Balanced Scorecard

Popularized by Kaplan and Norton in 1990

Scorecard with four perspectives:• Financial• Customer• Process• Learning growth

MDH BSC What is the template being used in MDH BSC?

MDH BSC Perspectives(2004 -2007)

MDH BSC Perspectives(2008 - 2012)

Financial Financial

Customer Customer

Process Process

Learning and Growth Learning and Growth (People)

Corporate Social Responsibility

Balanced Scorecard (Sample)Vision: Leading center of excellence and wellness in the Philippines

providing holistic quality patient carePerspective Goal Tactical

ObjectivePerformance Initiatives

(Programs) Measures Target

Financial Financial viability

Achieve profitable growth through normal operations

Gross revenue

XX% increase

Project Maximal Utilization of Services

Financial sustainability

Prevent account receivables

No. of admitted patients with account receivables –

less than XX%

Project Control of Account Receivables

Hospital Image and Reputation

Participate in programs of external award giving bodies promoting quality and excellence

Management Award

Submit at least 3 entries

Project External Awards for Excellence


providing holistic quality patient care

Perspective Goal Tactical Objective

Performance Initiatives (Programs) Measures Target

Customer Quality service and care

Provide quality services – prompt, effective, and courteous

Customer satisfaction

rating

≥90% Project Customer Feedback and Relations

Process Excellent operational mgt system

Develop effective / efficient quality management system

Conduct of Continual Improvement Program

in 70% of units per division

Project Continual Improvement


providing holistic quality patient care

Perspective Goal Tactical Objective

Performance Initiatives (Programs) Measures Target

People Competency Development

Provide training programs based on identified training needs

total number of units participated in one competency based training

At least 85%

People Growth and Development Program

Corporate Social Responsibility

Excellent corporate social responsibility program

Develop CSR Programs

No. of indigent patients served (inpatients)

Greater than 20XXtotal number

Project CSR

Has been useful in serving as

- communication

- alignment

- collaboration

- monitoring

- evaluation tool

in the implementation of strategic direction in Manila Doctors Hospital.

History of MDH BSC (2004-2011) Outcome

Q4. What are the most difficult (outstanding) challenges in delivering service excellence in hospitals?

Strategies

Challenges

Man Method Money Machine Monument Trends in Health

Design and Develop

√ √ √ √ √ √

Get CommittedSupport

√ √

Implement √ √ √ √ √ √

Evaluate √ √ √ √ √

Improve √ √ √ √ √ √

Goals and Objectives

of

Health Industry

Hospital

Alignment of Players, Processes and Systems

Integration of Processes and Systems

Coordination and Collaboration of Players

Alignment, Integration, Coordination and Collaboration (Teamwork)


Most difficult challenge –

how to manage the people with different mindset and behavior, particularly in the face of a paradigm shift

(community health outcomes targets, value-based delivery system, and corporate social responsibility)


ROJ’s Recommendations to meet the challenges:

• Facilitating strategies – Standards, IiP, and BSC

• Leadership – direction, motivation, commitment, innovation, etc.

• Managership – technical competence in planning, implementing and evaluating

• Communication – clear and closed-loop communication

• Education – mentoring and coaching of all concerned











Challenges

MDH Journey towards Excellence

1999 20122004 2009 201120102005

Integrated Value-based Health

Services (2012-2014)

V-M CSR Mission

Social Vision

PhilHealth BenchbookCenter of Excellence

Accreditation Canada International

ISO 9001:2000 /8

Balanced Scorecard

Baldrige Heath Care Criteria for

Performance Excellence

Investors in People

2007

Summary and Closing











Challenges

Why deliver excellent service in health industry?

Obligation

Health industry and its components owe it to the clients they have decided to serve!

Clients = communities with families and individual citizens therein.

They should do what is right for their clients.


Sustainability

With excellent service, value-based services,

• more clients, • maximal utilization of services,• enough revenues and incomes to

continue to operate and to expand the business of the hospital when and as needed!


Sustainability

With a social vision, corporate social responsibility,

there will be sustainability of the catchment community and, in the end, sustainability of the hospital!

Hospital Performance Excellence - a Long Journey

Advice:

Start early as the journey is long and tedious!

Need to be very very perseverant as there are a lot of challenges and things to learn!

Thank You!

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

0918-804-03-04For queries and for my Websites!

delivering service excellence in health industry

Health & Medicine